refund request by Ft2d73j4


									                      UI Tax Refund Request
Employer Account # ___________________

Employer Name:__________________________________

Doing Business As: ________________________________

I, _____________________________, am the owner or legal representative for the
owner, I am requesting a refund of the credit balance on the above referenced
employer account.

      I am certain that the credit balance on this account is accurate and should be
      refunded to me.

      I am uncertain how the credit balance happened on this account. Please
      review my account to make certain this is a valid credit balance before
      issuing a refund.

I certify that all quarterly reports have been accurately filed and paid, the check
resulting in the credit balance has cleared the bank, and that it is unreasonable to use
this credit on future tax filings.

________________________________________                         _______________
signature of owner or legal representative                       Date

Phone number

Return this form by FAX to 208-334-6301 or mail to:
       317 W MAIN STREET
       BOISE ID 83735-0760
If you have questions regarding your credit, call 208-332-3576 or toll free 800-448-2977.

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